Reviewer: Maria Luisa Veronese, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: June 7, 2004
* This presentation discusses off-label use of carboplatin in the treatment of seminoma.Presenter: J. Aparicio
Seminoma represents 45% of all germ cell tumors and 70%-80% of patients present with Stage I disease. Management of patients with Stage I seminoma after orchiectomy includes surveilance, radiation therapy or chemotherapy. Surveilance carries high stress, costs, and risk of late relapse (up to 10 years). Radiation therapy is associated with late toxicity including an increased risk of second tumors and 80% of patients are overtreated. A previous GG clinical trial has shown that adjuvant carboplatin may be restricted to patients with risk criteria (RC). RC shown to be important prognostic factors for relapse are tumor size >4 cm and invasion to the rete testis. The purpose of this study was to confirm the efficacy of this risk-adapted process using the new International criteria.
Materials and Methods
This study investigated the efficacy of a risk-adapted process using the new International criteria in the management of patients with stage I seminoma. The results indicated that 2 cycles of single agent carboplatin are effective in reducing the relapse rate in high risk stage I seminoma, However, the follow-up is still very short and there are no data regarding late toxicity using carboplatin in this patient population. Indeed, relapses occur within 2 years in 68.6% of patients and within 3 years in 93.4%. Of concern is the fact that all relapses occurred within the retroperitoneum suggesting that radiotherapy may be superior and should still be considered a first line approach for these patients.
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